Quality in Primary Care (2015) 23 (4): 241-248
2015 Insight Medical Publishing Group
Research Article
Research ArticleSatisfaction from Medical Service
Open Access
Patient
Provided by University Outpatient Clinic, Taif
University, Saudi Arabia
Waleed Samy MD
Professor, Internal Medicine Department, College of Medicine, Taif University and Medical director of Taif University Outpatient
Clinic KSA
Khaled A. Alswat MD
Assistant Professor, Internal Medicine Department, College of Medicine, Taif University and General Supervisor of Taif University
Outpatient Clinics, KSA
Abdel Hamid Serwah MD
Professor, Internal Medicine Department, College of Medicine, Taif University
Moustafa Abdel-Wahab
Dental Specialist and Quality Coordinator at Taif University Outpatient Clinic
Abstract
Objective: Primary health care involves a sustained
partnership between patients and providers that addresses
the patient's health needs over time. The degree of patients'
satisfaction is one among the mechanisms used in assessing
the quality of health care services. Hence, the aim of this study
is to determine patients' satisfaction regarding the quality of
medical care at the Taif University Outpatient Clinic.
Methods: An analytical observational study cross sectional
was conducted at the Taif University Outpatient Clinic. A
random sampling technique was employed over a five month
period; February 1st to June 31st 2013. A self administered
(Arabic/English) questionnaire was used.
Results: As regard patient-physician interaction, the
average percent mean score for satisfaction (7 items) was
(84.14 ± 7.97%) with the medication side effect explanation
Introduction
The need for continuous improvement of quality and
safety in the provision of patient care has become axiomatic.
The resulting paradigm shift from an acceptance of the status
quo to a drive for constant improvement in clinical practice
has required the engagement of multiple monitoring and
improvement strategies. Patients are the only source of data
for information on the dignity and respect with which they
are treated and the best source of information for patient
education and management. 1 Patient satisfaction is not only
important by itself, it has also been suggested as a care quality
indicator in developed countries. 2 It can contribute to clinical
care improvement strategies, health care services and delivery.
3
Nowadays, patients are looking for hassle free, high quality
and quick services. This demand is only possible with optimum
utility of the resources through multitasking in a single window
system of the OPD. 4, 5
Today, many patients receive much of their health care as
outpatients, a trend that many see as benefiting the health system
is the least one (68%), while, the overall patients' satisfaction
with administrative efficiency and clinic setup environment (5
items) was 89.4 ± 5.64 % with opinion about care provision got
least satisfaction (83%).
Conclusion: The majority of patients were satisfied with
the patient-physician interaction, technical competency,
administrative efficiency and clinic set up an environment at
the Taif University Outpatient Clinics.
Recommendations: Continuous evaluation of patient
satisfaction is to be part and parcel of the general health care
delivery by Outpatient clinics of Taif University to ensure
patient satisfaction.
Keywords: Patient satisfaction, Medical services, Quality
of medical care, Outpatient Clinic
. Much of the move toward outpatient care in the USA has been
driven by third-party payers in an effort to control expenses.
This change has challenged health care providers to find safe
and effective ways to deliver care on an outpatient basis. Patient
satisfaction can be defined as the extent of an individual's
experience compared with his or her expectations and is related
to the extent to which general healthcare needs and conditionspecific needs are met. 7 Patient dissatisfaction occurs when the
patients’ experience of the service falls short of expectations,
while patient’s satisfaction occurs when the patients’ experience
of the service exceeds their expectations.
6
The importance of the differentiation is needed because
though satisfaction is essential for keeping high loyalty of
the patient, dissatisfaction is crucial because it may lead to
unwanted patient future behavior. Patient’s feedback triggers a
real interest that can lead to a change in their culture and in their
perception of patients. 8 It is difficult to measure the satisfaction
and the gauze responsiveness of health systems as not only the
clinical but also the non-clinical outcomes of care do influence
242
Waleed Samy
Profession
the customer patient satisfaction. 9 Patients' perceptions about
health care systems seem to have been largely ignored by health
care managers in developing countries. Patient satisfaction
depends upon many factors such as: Quality of clinical services
provided, availability of medicine, behavior of doctors and
other health staff, cost of services, hospital infrastructure,
physical comfort, emotional support, and respect for patient
preferences. 10 Mismatch between patient expectation and the
service received relates to decreased satisfaction. 11
Employee
38%
TAIF University Outpatient Clinic (TUOC) is a place
that provides a broad range of medical services to sick and
injured patients. Well designed, implemented and used patient
satisfaction evaluation systems are expected to help TUOC
to improve both clinical and managerial activities. Therefore,
assessing patient perspectives gives them a voice, which can
make public health services more responsive to people's needs
and expectations. 12, 13
student
Staff
27%
35%
Physician Respect During
Examination
This study is conducted to determine the satisfaction of
patients about the services provided in the TUOC.
75%
Methodology
This study employed a self-administered questionnaire
that required less than 10 minutes to be completed and which
has been thought to be an efficient and effective tool for
collecting information (Figure 1). The patients/respondents
were consecutively selected and a questionnaire was developed
to evaluate their satisfaction regarding the availability,
accessibility and convenience of the TUOC services, including
their perception about the behavior of staff, including a list of
the amenities that they feel are important to them as clients.
A Random sampling technique over a five-month period was
employed starting from February 1st till the end of June 2013. All
patients accepted to participate in this study. The questionnaire
was based designed to measure the criteria affecting patientphysician interaction (7 items) and patient’s satisfaction with
administrative efficiency and clinic setup environment (5 items).
The questionnaire was drafted in the Arabic and English
with a 5-point Likert response scale ranging from 1 (strongly
disagree) to 5 (strongly agree). The 5-point scale was later
transformed during data analysis to a 3-point response scale
ranging from 1 (disagree) to 3 (agree), with 2 corresponding to
‘‘uncertain’’. Mixtures of negative and positive statements were
set to ensure that there is no standard format for answering.
Therefore, participants needed to read each item carefully
before responding. The questionnaire used has face validity was
established experts. It was pilot tested on a subset of participants
Nationality
Non – Saudi
Saudi
36%
64%
17%
7%
Always
Often
Sometimes
1%
No
Physician Listen to You Carefully
70%
60%
50%
40%
30%
20%
10%
0%
Always
Often
Sometimes
No
Physcian Explain Your Condition
65%
23%
9%
3%
Always
Often
Sometimes
No
with principal components analysis and revision. The somewhat
irrelevant questions be dropped. It was administered in private
setting with guidance. Percentages of agreement on the 2 main
disciplines of satisfaction were calculated and presented; the
mean percentages of satisfaction were calculated to estimate the
overall ranking analysis of individual satisfaction disciplines.
Statistical analysis
The data were coded and keyed into the Statistical Package
Patient Satisfaction from Medical Service Provided by University Outpatient Clinic, Taif University, Saudi Arabia 243
Phscian Explain Way of Taking Medication
70%
60%
50%
Taif University, approved this study. The waiver of the informed
consent process was approved on the basis of the questionnaire’s
being anonymous and self-administered and containing no
identifiers.
Results
40%
30%
20%
10%
0%
Always
Often
Sometimes
No
Physician Explain Cuase of
Medication
70%
60%
50%
40%
30%
20%
10%
0%
Always
Often
Sometimes
No
Physcian Explain Medication Side
effects
46%
22%
19%
13%
Always
Often
Sometimes
No
Patient Satisfaction With Provided
Treatment
45%
35%
18%
A total of 383 patients agreed to participate within the study.
244 patients (64%) were Saudi nationals whilst the remaining
139 patients (36%) were Non Saudis with significant statistical
difference between both groups. 214 patients were female
(56%), with 169 patients were male (44%) with no significant
statistical difference. As regards patient’s occupation, 146
participate were University staff (38%), 134 students (35%), and
103 (27%) employees with no significant statistical difference
(Table 1). It was noticed that the majority of the patients was
satisfied with the patient-physician interaction as regard, respect
during examination (92%), listen to you carefully (88%),
explain your condition in a clear way (88%), explain the cause
of medication (87%), explain medication side effects (68%),
explain way of taking medication (86%) and satisfaction by way
of treatment (80%) of participating patients (table 2& 3). Tables
4 and 5 showed that most of participated patients agreed with
the technical competency items, administrative efficiency and
clinic setup, less waiting time (92%), medication availability
(92%), cleanliness level (96%), opinion about the level of care
provided (83%), and recommendation (84%).
An overall ranking of factors related to satisfaction was done
by calculating the mean percentage of agreement regarding
the different disciplines of satisfaction among the studied
group (table 4). The mean percentage of agreement for the 4
disciplines was 79.5% denoting a high level of satisfaction
(table 6). The association between respondents’ nationality and
characteristics of the two disciplines of satisfaction revealed no
significant differences between Saudi and Non Saudi, gender
and occupation shown by the P-values in (tables 7, 8 and 9).
Discussion
Patient care quality is a major concern of health care
providers all over the world. The most cited reason for seeking
care in these clinics is attributed to perceptions of high quality
service and concern for the patients’ well-being. 15 All patients
agreed to participate in the study and answer the questions
included in the questionnaire and share in it with a response rate
100%. 64% of participants are Saudi people. This study serves
as a situation analysis of factors affecting patient satisfaction. As
Table 1: Participants’ related general data.
2%
Always
Often
Sometimes
Saudi
N (%)
No
for the Social Sciences software version 19 (SPSS Inc.,
Chicago, IL) used in Windows 7. Descriptive analysis followed
by inferential statistics was done. Percentages and means were
calculated for qualitative and quantitative data. T-test and
Chi-square test (X2) were performed to statistically analyze
qualitative data. A P-value of 0.05 was considered. 14
Ethical consideration
The Research Ethics Committee of the College of Medicine,
Nationality
Gender
244 (64%)
Non – Saudi
N (%)
Total
N (%)
P
139 (36%) 383 (100%) 0.001*
Male
Female
38 (10)
345 (90)
Staff student Employee
Profession 146 134
103 (27)
(38) (35)
383(100)
0.983
383 (100)
0.355
244
Waleed Samy
Table 2: Participants’ satisfaction as regard patient-physician interaction questionnaire details.
Answer
Question
Total
N (%)
No
N (%)
Sometimes
N (%)
Often
N (%)
Always
N (%)
Physician respect during
examination
2 (1)
29 (7)
64 (17)
288 (75)
383 (100)
Physician listen to you
carefully
12 (3)
34 (10)
90 (23)
247 (64)
383 (100)
Physician explain your
condition in clear way
11 (3)
34 (9)
88 (23)
250 (65)
383 (100)
Physician explain cause of
medication
19 (5)
31 (8)
107 (28)
226 (59)
383 (100)
Physician explain medication
side effects
50 (13)
73 (19)
84 (22)
176 (46)
383 (100)
Physician explain way of
taking medication
11 (3)
45 (12)
91 (24)
236 (62)
383 (100)
Your satisfaction with way of
treatment
8 (2)
69 (18)
134 (35)
172 (45)
383 (100%
Table 3: Participants’ satisfaction as regard patient–physician
interaction conclusive.
Question
Answer
Non-satisfied Satisfied
N (%)
N (%)
Total
Respect during
examination
Listen to you
carefully
Explain your
condition in clear way
31 (8)
352 (92)
383 (100)
46 (12)
337 (88)
383 (100)
45 (12)
338 (88)
383 (100)
Explain cause of
medication
50 (13)
333 (87)
383 (100)
123 (32)
260 (68)
383 (100)
56 (14)
327 (86)
383 (100)
77 (20)
306 (80)
383 (100)
Explain medication
side effects
Explain way of taking
medication
Satisfaction with way
of treatment
regard patient-physician interaction, the average percent mean
score for satisfaction (7 items) was (84.14 ± 7.97%), as regard
to respect during examination (92%), listen to you carefully
(88%), explain your condition in a clear way (88%), explain
the cause of medication (87%), explain medication side effects
(68%), explain way of taking medication (86%) and Satisfaction
with way of treatment (80%) of participating patients with
doctor explain medication which is a very important aspect in
the patient-physician satisfaction domain represented with 68%
of satisfaction among the studied sample and this should be
discussed carefully with clinic physician. From these findings,
the participants were satisfied with the provision of information.
This agrees with a similar study in which it was found that
provision of information is ranked higher by patients in terms
of factors contribute to satisfy. 16 Another study found patients’
satisfaction correlated strongly with the amount of information
patients received from their physicians.17 Despite the high
ranking of this by patients, many physicians still try to fully
understand patients’ information needs.18
However the overall results on satisfaction do not tell us about
the weaknesses of the service or the problem encountered. Only
further probing on the specific aspect of care will reveal areas
of expressed dissatisfaction. 19 Sharma et al,20 concludes that the
overall satisfaction regarding the doctor-patient, professional
and behavioral communication was more than 80% at almost all
the levels of health care facilities. In total, 55% of respondents
opined that doctors have shown little interest to listen to their
problems. The overall patients’ satisfaction with administrative
efficiency and clinic setup environment (5 items) was 89.4 ±
5.64 % which considered very high. The least satisfaction was
from the opinion about care provided 83%. Most participants
(92%) were pleased with the time spent on the facility. Many
studies have documented the relationship between waiting for
service and overall satisfaction. Longer waiting times being
associated with decreased patient satisfaction. 21 In another
study, it was hypothesized that “time factor” (time spent on
scheduling and waiting time in the clinic) is a major contributor
to overall satisfaction and this factor was modified and proven
that waiting times significantly correlated well with overall
satisfaction. 22
There is no significant statistical difference between Saudi
and Non Saudi Nationalities, gender and occupation regarding
the patient–physician interaction and patients’ satisfaction
with administrative efficiency and clinic setup environment
satisfaction. In contrast to Kulkarni et al in 2008, who found
that level of satisfaction among patients was better with
Patient Satisfaction from Medical Service Provided by University Outpatient Clinic, Taif University, Saudi Arabia 245
Table 4: Participants’ satisfaction as regard administrative efficiency and clinic setup environment questionnaire details.
Question
Waiting time
Medication
availability
Cleanliness level
5-15 Min
N (%)
295 (77)
Yes
N (%)
165 (43)
Poor
N (%)
Opinion about level
of care provided
Recommendation
Answer
15-30 Min
30-45 Min
>45 Min
N (%)
N (%)
N (%)
57 (15)
20 (5)
11(3)
No
Sometimes
Rarely
N (%)
N (%)
N (%)
19 (5)
188 (49)
11 (3)
Average
Excellent
N (%)
N (%)
245 (64)
11 (3)
127 (33)
Weak
N (%)
7 (2)
No
N (%)
23 (6)
Average
N (%)
58 (15)
Sometimes
N (%)
38 (10)
Good
N (%)
115 (30)
Often
N (%)
115 (30)
Total
383 (100)
383 (100)
383 (100)
Excellent
N (%)
203 (53)
Always
N (%)
207 (54)
383 (100)
383 (100)
Table 5: Participants’ satisfaction as regard administrative efficiency and clinic setup environment conclusive.
Question
Answer
Waiting time
Less than 30 Min
N (%)
Medication availability
Yes
N (%)
Cleanliness level
Average& excellent
N (%)
352 (92)
353 (92)
372 (96)
Opinion about level of care
provided
Recommendation
Good& excellent
N (%)
318 (83)
Often& always
N (%)
(84) 233
doctor’s behavior of (87.76%), while dissatisfaction was found
to be more with administrative efficiency and clinic setup
environment as cleanliness (56.01%). 23 Up to our knowledge
and research we did not find any satisfaction study in primary
health care centers inside KSA especially university centers to
compare our results with them. This study will act as a guide for
health care staff members on both male and female campuses
to ensure patient satisfaction as an indicator for the quality of
medical services, being part of the total quality management
policy of the university.
Conclusion
This study that the majority of patients were satisfied with
the patient-physician interaction and administrative efficiency
30 Min or more
N (%)
31 (8)
Total
383 (100)
No or rarely
N (%)
30 (8)
383 (100)
Poor
N (%)
11 (3)
383 (100)
Average& weak
N (%)
65 (17)
383 (100)
No& Sometimes
N (%)
61 (16)
383 (100)
and clinic setup environment at the University Outpatients
Clinic, Taif University.
Recommendation
Continuous supervision of patient satisfaction levels
should be done to deduce methods to improve health care
service delivery by the outpatient clinic, Taif University, and
measures should be taken to reduce and eliminate any source of
dissatisfaction.
Limitations of the study
This is only a baseline study with a limited sample size,
which was carried out for evaluating outpatient clinic services
as it was a self-funded project. A continuous ongoing process of
246
Waleed Samy
Table 6: Overall satisfaction for the four main disciplines.
Item
Minimum
Agree %
Maximum
Agree %
Median
Agree %
M± SD
Patient–physician interaction
68
92
87
84.14±7.97
Administrative efficiency and clinic
setup environment
83
96
92
89.4±5.64
Table 7: Association between Nationality and characteristics of the two disciplines of satisfaction.
Item
Nationality
Saudi
Non-Saudi
N (244)
N (139)
Total
N= 383
patient–physician interaction
•Respect during examination
•Listen to you carefully
•Explain your condition in clear way
•Explain cause of medication
•Explain medication side effects
•Explain way of taking medication
•Satisfaction with way of treatment
165
159
158
162
111
162
145
187
178
180
171
149
165
161
352
337
338
333
260
327
306
Administrative efficiency and clinic setup
environment.
•Waiting time
•Medication availability
•Cleanliness level
•Opinion about level of care provided
•Recommendation
163
162
173
153
151
189
191
199
165
171
352
353
372
318
322
P
0.708
0.242
0.559
0.593
0.186
0.599
1.000
0.579
0.451
0.558
0.136
0.329
Table 8: Association between Gender and characteristics of the two disciplines of satisfaction.
Item
Gender
Male
N (169)
Total
N= 383
Female
N (214)
P
patient–physician interaction
• Respect during examination
• Listen to you carefully
• Explain your condition in clear way
• Explain cause of medication
• Explain medication side effects
• Explain way of taking medication
• Satisfaction with way of treatment
165
162
155
185
124
139
145
187
175
183
175
136
188
161
352
337
338
333
260
327
306
1.000
0.386
1.000
0.788
0.711
1.000
1.000
Administrative efficiency and clinic setup
environment.
• Waiting time
• Medication availability
• Cleanliness level
• Opinion about level of care provided
• Recommendation
164
162
175
142
158
188
191
197
176
164
352
353
372
318
322
0.853
1.000
0.776
0.682
0.677
Patient Satisfaction from Medical Service Provided by University Outpatient Clinic, Taif University, Saudi Arabia 247
Table 9: Association between Occupation and characteristics of the two disciplines of satisfaction
Item
Occupation
Total
N= 383
P
95
91
83
89
64
86
99
352
337
338
333
260
327
306
0.948
0.967
0.784
0.895
0.761
0.906
0.848
95
105
100
90
85
352
353
372
318
322
0.819
0.983
0.965
0.791
0.065
Staff
N= 146
student
N= 134
Employee
N= 103
patient–physician interaction
• Respect during examination
• Listen to you carefully
• Explain your condition in clear way
• Explain cause of medication
• Explain medication side effects
• Explain way of taking medication
• Satisfaction with way of treatment
134
128
132
127
99
125
119
123
118
123
117
87
116
98
Administrative efficiency and clinic setup
environment.
• Waiting time
• Medication availability
• Cleanliness level
• Opinion about level of care provided
• Recommendation
135
139
141
120
124
122
119
131
108
113
evaluating the services is required for getting definitive results.
Also a limited number of patients included in the study, we
believe that the scores obtained from the present study can serve
as a baseline against which to compare the results from future
surveys.
ACKNOWLEDGEMENT
We thank the patients for the support and time provided by
them. We also owe thanks to the Medical Staff of the outpatient
clinic for permission to conduct the study amidst recent
controversies regarding health care provider at the clinic.
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ADdress for Correspondence
Moustafa Abdel-Wahab, Outpatient Clinic, Taif University,
Taif, Hawia, KSA, Tel: +966/548002133, E-mail:
[email protected]